We present the case of a 37-year-old Afghani man with a history of childhoo
d diphtheria, who was diagnosed with bilateral vocal cord paralysis at age
15 years, At about this time he developed progressive muscular wasting and
distally predominant weakness, and subsequently developed respiratory insuf
ficiency, necessitating nocturnal ventilatory support. His examination sugg
ested a distal symmetric sensorimotor neuropathy, and his brother was simil
arly affected, although to a lesser degree. Electromyography (EMG) and nerv
e conduction studies revealed this process to be purely axonal. A diagnosis
of possible hereditary motor and sensory neuropathy (HMSN) type IIc, hered
itary axonal polyneuropathy with vocal cord paralysis, is proposed, althoug
h the question of early diphtheritic involvement of the Vocal cords and per
ipheral nerves is also considered. (C) 2000 John Wiley & Sons, Inc.